Blair Horner: Questions About Health Care Reform

This week the US Supreme Court will take up the question of the constitutionality of federal health care reform, the Affordable Care Act. The Court has scheduled three days for debate, each day focusing on a different challenge to the law.

Monday’s review focuses on whether the Court can act at all on the legal challenge. The Court typically does not take up a challenge unless someone has been “harmed” by the law. The Affordable Care Act requires virtually all Americans to obtain health insurance from their employer, the state, or purchase it individually. Since that “mandate” goes into effect on January 1, 2014, no one has yet been required to pay a penalty for failing to purchase insurance, so no one has been “harmed.” One of the lower courts already decided that the law is not ripe for challenge and thus argued that no decision can be made until penalties occur.

Wednesday’s review examines whether the Affordable Care Act’s expansion of Medicaid insurance coverage unconstitutionally forces states to pick up their small portion of the tab for covering the poor.

But the main debate is on Tuesday. That’s the day the court will hear arguments over the “individual mandate” section of the Affordable Care Act. That’s the section that requires virtually every American to obtain insurance. Opponents argue that the law unconstitutionally expands the power of the federal government to regulate individuals’ decisions for insurance coverage.

Supporters point to a long, and well established, series of court decisions that have upheld the power of the federal government to regulate commerce and to require payment of taxes.

No one knows how the US Supreme Court will rule, yet the hearings themselves are used by opponents of the law to block New York’s efforts to prepare to deal with the Affordable Care Act’s requirements. Opponents are putting their own ideological or partisan concerns ahead of the needs of New Yorkers.

The only issue up for legislative action is the creation of a health insurance exchange. The health insurance exchange is the entity that the uninsured and small businesses will use to obtain affordable coverage. Required under federal law to be in place by 1/1/2014, the exchange would offer individuals and employers a choice of affordable, high quality insurance plans. Lower income individuals and small employers would be eligible for subsidies to help pay for the coverage. The program is modeled on the law in the state of Massachusetts. 98 percent of Massachusetts residents are now covered by health insurance.

In New York, 15 percent of the population does not have health insurance and that number has been growing. In 2010, the US Census reported that nearly 2.9 million New Yorkers lacked health insurance. For cancer patients, lack of insurance can be devastating -- both physically and financially. Estimates are that 10 percent of cancer patients lacked coverage at the time of diagnosis and that one-third of cancer survivors report losing coverage at some point after their diagnosis.

Annually, about 100,000 New Yorkers are diagnosed with cancer. Ten percent of that number translates into an estimated 10,000 New York cancer patients who lack health insurance.

New Yorkers without health insurance need action, not rhetoric from their elected representatives. For people with chronic illnesses, like cancer, the lack of health insurance can be catastrophic – both physically and financially. The Senate leadership says they have unanswered questions about the health exchange. One question to them is – What will you say to uninsured cancer patients if you block their only real hope for insurance coverage?

Since opponents offer no alternative, they have nothing to say except “good luck.” Even in the unlikely case the US Supreme Court struck down the entire federal law, why not move ahead to create an exchange along the lines of the one in Massachusetts? When it comes to the lack of health insurance for those with chronic illnesses, delay can be deadly. New York must act now.

Blair Horner is the Vice President for Advocacy for the American Cancer Society, Eastern Division. His commentary does not necessarily reflect the views of the American Cancer Society.

The views expressed by commentators are solely those of the authors, and do not reflect the views of this station or its management.